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Clarification: recent update to HCC auto-approval policy

Clarification: recent update to HCC auto-approval policy

UPDATE: Following the publication of the memo below, the OPTN/UNOS Executive Committee approved a plan for the OPTN/UNOS Liver and Intestinal Organ Transplantation to seek public comment through January 31 on a proposal to amend the recently implemented HCC policy. The proposal would restore a provision for a subset of candidates with treated HCC lesions to continue to receive automatic approval of HCC exception scores at the time of extension, if their treated lesions fall below eligibility criteria for an initial exception request. You may read the proposal and offer comment here.

Yolanda Becker, M.D., President of the OPTN/UNOS Board of Directors, sent the following message to liver transplant programs on December 26, 2017:

On December 12, 2017, UNOS implemented the Changes to HCC Criteria for Auto Approval Policy approved by the Board in December 2016. The aim of this policy revision was to standardize criteria for exception points granted for downstaged tumors and set specific criteria for upper limits of AFP.

The changes included modifications to the required eligibility criteria for candidates to receive an automatic extension of their currently approved HCC exception. The revised policy requires that patients must “continue to meet initial eligibility criteria” to receive the automatic extension. This references meeting T2 criteria or new AFP criteria at the time of listing. Under the new policy, HCC candidates who initially qualified, and were then successfully treated with residual lesions below T2 criteria at the time of renewal, are no longer eligible for auto-approved at their next extension. They now require review by their respective regional review board.

The Liver Committee has asked the Executive Committee to consider what options are available for restoring automatic approval for “below T2 down-staged” candidates. We will provide an updated communication as soon as we have determined next steps.

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